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Irregular And Asymptomatic Periods. Diagnosed Of A Cyst On Ovary. Using Progyluton. What Is Alternative Treatment.
Hey there ..
Im a medical student i wanna ask an obgyn a Q abt a condition of an AUB
Brief history
She is a 22 year old female , single , her BMI about 19 and she is virgin.
her menarche was on 17 year old and this is too late for an avg age of females first period at 13 year , and since that time until now her menstural cycle was not regular and she used to get painless cycle !! Which mean its anovulatory cycle or not ?? And the period varies from 1 to 3 days maximum and once the period came she didnt feel it , its asymptomatic period !!
So bcz of that i advices her to visit an obgyn doctor to evaluate her condition and the findings was
A cystic mass abt 1 cm on left ovary and her hormones within normal range on hormonal profile but its irregular and variable
No sings and symptoms of PCOS or premature ovarian failure
So her doctor planned her to regulate her cycle with progyluton ; whichs a mixture of estrogen and progesterone derivatives to mimic the physiological hormone of her body , and she complete 1 course of this medication for 21 days and from the last tablet until now was 3 days and the period didnt come yet ..
My Qs are ;
What is going on with this lady , i need your differential diagnosis related to her history ? Why her hormones are imbalance!!
I need from u to tell me how is this medication will regulate her cycle and her hormones ??
I need from u to tell me what the avg duration to use this medication in order to regulate her cycle ??
And if its not regulated with this management what is the next step ??
And thank u for your attention ^_^
Im a medical student i wanna ask an obgyn a Q abt a condition of an AUB
Brief history
She is a 22 year old female , single , her BMI about 19 and she is virgin.
her menarche was on 17 year old and this is too late for an avg age of females first period at 13 year , and since that time until now her menstural cycle was not regular and she used to get painless cycle !! Which mean its anovulatory cycle or not ?? And the period varies from 1 to 3 days maximum and once the period came she didnt feel it , its asymptomatic period !!
So bcz of that i advices her to visit an obgyn doctor to evaluate her condition and the findings was
A cystic mass abt 1 cm on left ovary and her hormones within normal range on hormonal profile but its irregular and variable
No sings and symptoms of PCOS or premature ovarian failure
So her doctor planned her to regulate her cycle with progyluton ; whichs a mixture of estrogen and progesterone derivatives to mimic the physiological hormone of her body , and she complete 1 course of this medication for 21 days and from the last tablet until now was 3 days and the period didnt come yet ..
My Qs are ;
What is going on with this lady , i need your differential diagnosis related to her history ? Why her hormones are imbalance!!
I need from u to tell me how is this medication will regulate her cycle and her hormones ??
I need from u to tell me what the avg duration to use this medication in order to regulate her cycle ??
And if its not regulated with this management what is the next step ??
And thank u for your attention ^_^
Thu, 3 Oct 2013
Hello,
Thanks for the query to H.C.M. Forum.
Since you are yourself medical student so I think you will understand few things without any difficulties .
No doubt she is lean & thin , that is a different question as her B M I below average , may be due to malnutrition as I have seen in many cases ,so at present we will only discuss about her present disease .
Let me explain few sign & symptoms so that you get answer few questions.
P C O S id recognised as an entity occurring in young females with CHRONIC ANOVULATION with estrogen presence & having the following sign & symptoms clinical as well laboratories findings .
1 Androgen excess manifesting as HIRSUTISM & acne.
2 Menstrual irregularities ,dysfunctional uterine bleeding or amenorrhea.
3 obesity with glucose intolerance.
Now note down lab reports ( abnormal).
1 Alteration in LH / FSH ratio .
Mind it the normal L H level is different in different phases so compare it accordingly , same is with the level of F S H.
2 Elevated serum testosterone & androstenedione levels
3 Ultrasound finding, of atretric follicles with increased ovarian stroma.
.
Now this is as above mentioned is about PCOS.
Polycystic changes in the ovaries have also been observed in the following endocrine disorders as ,
Cushing's syndrome,
hyperthyroidism,
hypothyroidism,
late onset adrenal hyperplasia, or
different type of ovarian tumors.
So I think you have received your answer. Good luck. Dr. HET
Thanks for the query to H.C.M. Forum.
Since you are yourself medical student so I think you will understand few things without any difficulties .
No doubt she is lean & thin , that is a different question as her B M I below average , may be due to malnutrition as I have seen in many cases ,so at present we will only discuss about her present disease .
Let me explain few sign & symptoms so that you get answer few questions.
P C O S id recognised as an entity occurring in young females with CHRONIC ANOVULATION with estrogen presence & having the following sign & symptoms clinical as well laboratories findings .
1 Androgen excess manifesting as HIRSUTISM & acne.
2 Menstrual irregularities ,dysfunctional uterine bleeding or amenorrhea.
3 obesity with glucose intolerance.
Now note down lab reports ( abnormal).
1 Alteration in LH / FSH ratio .
Mind it the normal L H level is different in different phases so compare it accordingly , same is with the level of F S H.
2 Elevated serum testosterone & androstenedione levels
3 Ultrasound finding, of atretric follicles with increased ovarian stroma.
.
Now this is as above mentioned is about PCOS.
Polycystic changes in the ovaries have also been observed in the following endocrine disorders as ,
Cushing's syndrome,
hyperthyroidism,
hypothyroidism,
late onset adrenal hyperplasia, or
different type of ovarian tumors.
So I think you have received your answer. Good luck. Dr. HET
I find this answer helpful
Hello, I would be happy to help you with your question.
The patient you are describing should have been diagnosed with 'primary amenorrhea' and had a full workup at the age of 17. Since that time, she seems to have remained anovulatory in terms of her cycles. This could be related to:
1. Pituitary disease
2. Hypothalamic disease
3. Being underweight (19 is low normal)
4. Uterine problems - outflow obstruction
The evaluation is a systematic approach that is more than I can fit into the answer (and is best asked as a Premium Specialty question - i.e. paid)
I hope that this helps!
The patient you are describing should have been diagnosed with 'primary amenorrhea' and had a full workup at the age of 17. Since that time, she seems to have remained anovulatory in terms of her cycles. This could be related to:
1. Pituitary disease
2. Hypothalamic disease
3. Being underweight (19 is low normal)
4. Uterine problems - outflow obstruction
The evaluation is a systematic approach that is more than I can fit into the answer (and is best asked as a Premium Specialty question - i.e. paid)
I hope that this helps!
I find this answer helpful
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